Making scientific articles free and available to all is only fair to the taxpayers who support research and the developing countries who need it, a Nobel laureate at the forefront of the open-access movement said at a forum today, but the editor of a prestigious journal likened that approach to vanity publishing.

Dr. Harold Varmus, head of Memorial Sloan-Kettering Cancer Center and former director of the National Institutes of Health, and Emilie Marcus, executive editor of Cell Press, took opposing positions at a conference on scientific publishing organized by graduate students at Harvard Medical School.

"The public pays a lot for the research that's published in this country," said Varmus, the keynote speaker. He shared the 1989 Nobel in medicine for his work with genes that cause cancer. "Why should they have to pay for it twice to see the results?"

During a later panel discussion, Marcus countered that having scientists pay journals to publish their work, which is the way open-access journals offset costs traditionally borne by subscribers, ignores the value that journals and editors bring.

"When journals derive money from readership, the pressure is on the journal to provide value important to the people who read it. I as editor focus on creating a journal you as readers want to read," she said. "The philosophy of publishing with the author paying can turn publishing into a vanity publishing model."

In opening remarks, Dr. Steven Hyman, provost of Harvard University, reminded the mostly young crowd of about 120 that when he was a student, he had to scramble to feed nickels into Xerox machines to copy papers from bound volumes of journals in the stacks of Countway Library.

Now scientists have the opportunity to make their work freely and immediately available online, with the same peer-review process in place, Varmus said. They pay a fee of up to $3,000 for publication in journals of the Public Library of Science.

Varmus also hopes for an encyclopedic and timely repository of all research, whatever journal publishes it originally, so people can search for all sorts of information without having to pay for it -- a concern for poorer nations around the world. PubMed Central was formed in 1999 with that idea in mind when Varmus was near the end of his tenure at NIH, but with only 5 percent of NIH-funded researchers contributing to it, and only several months after publication, the repository falls short of that goal, he said.

Marcus said articles published by Cell's parent company, Elsevier, are deposited on behalf of all NIH-funded authors into PubMed Central 12 months after publication at no charge.

After seven years of decline, smoking rates across the nation are stuck at about 21 percent, where they have been from 2004 to 2006, federal officials said, a leveling-off possibly linked to greater marketing efforts by tobacco companies and fewer anti-smoking dollars for public health campaigns, the Los Angeles Times and other news outlets say today.

The trend in smoking rates mirrors what has also happened in Massachusetts, according to a story in the Globe in July. Cigarette sales increased after the state dropped its tough anti-smoking ads (like the one at left) in 2001, Stephen Smith reported after the state Legislature voted to reinvigorate the tobacco-control program. Its budget was boosted to $12.75 million for next year, from $8.25 million this year.

A CDC official blamed reduced spending on anti-tobacco campaigns and bigger marketing budgets from cigarette companies for the national numbers.

"What is happening doesn't have to happen," Dr. Matt McKenna, director of the CDC's Office on Smoking and Health, told the LA Times yesterday. "With appropriate support and efforts and counter-marketing, tens of thousands of people don't have to die."

Thousands of home health assistants in Massachusetts overwhelmingly voted to join the powerful Service Employees International Union, giving the union strong momentum as it moves toward its larger goal of attempting to organize about 55,000 workers at Boston's teaching hospitals.

Again breaking its records, the Pan-Massachusetts Challenge this year raised more than twice the amount ever contributed to charity by an athletic fund-raising event in the United States - $33 million - and for the first time will donate the whole sum to cancer care and research, according to organizers of the annual bicycle ride.

Physicians for Social Responsibility predicted yesterday that healthcare for Iraq veterans could top $650 billion, another warning of a looming social crisis as thousands of veterans struggle with mental and physical disabilities and other disruptions to family life.

Amgen Inc. and Johnson & Johnson have strengthened warnings about the risks, including death and stroke, associated with their blockbuster anemia drugs.

People with arthritis and their families are invited to a free seminar Saturday with experts gathered in Boston for a national conference of the American College of Rheumatology.

Twenty health care professionals and researchers will talk about progress in the diagnosis and treatment of arthritis as well as how to manage the disease. The event is organized by the rheumatology group, the United States Bone and Joint Decade initiative, the Arthritis Foundation and the American Academy of Pediatrics.

The forum will be from 1 to 4:30 p.m. Saturday at the Westin Boston Waterfront Hotel, 425 Summer St. For more information, call (617) 219-8224.

Researchers exploring connections between breast cancer and environmental exposures will use state funds to study chemicals found in households and the workplace.

The University of Massachusetts at Lowell, the Silent Spring Institute -- a nonprofit that researches the links between health and the environment -- and the Massachusetts Breast Cancer Coalition will get $250,000 earmarked by the legislature for the project.

The Silent Spring Institute will continue its work examining household dust for links to cancer, UMass-Lowell will pursue the effects of chemicals at work and at home, and the advocacy coalition will publicize findings they reach, Richard Clapp, adjunct professor in the school's School of Health and Environment, said in an interview.

“We’re trying to lay the groundwork for innovative work in Massachusetts with new lines of research,” said Clapp, who is also professor of environmental health at Boston University School of Public Health.

The results of an organizing vote by home healthcare aides, to be made public today, could give the powerful Service Employees International Union added momentum as it seeks to organize workers in Boston's teaching hospitals.

Blood pressure drugs, caffeine, and fish oil all may help treat, prevent, or delay Alzheimer's disease, researchers found in separate studies.

A unit of CVS Caremark Corp., the largest US drugstore chain by number of stores, sued rival Walgreen Co., claiming it prematurely canceled contracts to fill prescriptions for 70,000 people.

A shot that robs smokers of the nicotine buzz from cigarettes showed promise in midstage testing and may someday offer a radically new way to kick the habit.

Dr. Nancy Andrews, who earlier this year left Harvard Medical School to become the first female dean of the Duke University School of Medicine, asks why it’s still big news when a woman takes the top post in academic medicine.

Writing in tomorrow’s New England Journal of Medicine, she answers her own question. Only 14 of 124 US medical school deans are women, and the pipeline for leadership at the department chair level is almost empty, despite similar numbers of men and women graduating from medical school.

“If institutions are to accelerate the emergence of more female deans, then they will need to consider women who have not stepped on every rung of the traditional academic career ladder,” she writes.

The article that follows Andrews’ essay takes a look earlier in medical careers, focusing on family leave policies for male and female doctors during their residency programs.

Dr. Reshma Jagsi of the University of Michigan and Dr. Nancy J. Tarbell and Dr. Debra F. Weinstein, both of Harvard Medical School, say while federal law allows family leave, policies set by graduate programs and medical-specialty boards can make that unworkable if they require training to be completed within a fixed time frame.

“It is unrealistic and inappropriate to expect trainees to delay childbearing or to forgo spending critical time with their infants,” they write. “We therefore need new solutions.”

“Activity, attitude and determination, that’s it. All you need to keep going,” she said. “Oh, and you’ve got to have a sense of humor, or you’re licked.”

She would sing to babies in the nursery or to staff on the desk, Deirdre Woolley, nurse manager of obstetrics, said in a memo sent to hospital staff by Rabbi Terry Bard, director of pastoral care and education.

“We were the lucky ones that Rose chose to work with and we are better for it every day,” she said.

Operating room fires have received less attention than other potential hazards such as wrong-site surgery, but fires have seriously injured and even killed patients. And new data show that they are more common than previously believed.

Being overweight boosts the risk of dying from diabetes and kidney disease but not cancer or heart disease, and carrying some extra pounds appears actually to protect against a host of other causes of death, federal researchers reported yesterday.

Energy drinks, the increasingly popular high-caffeine beverages, may do more than give people a jolt of energy - they may also boost heart rates and blood pressure levels, researchers said yesterday.
Emergency departments and patients in psychiatric crisis are both victims of a healthcare system that increasingly relies on emergency care to cover gaps in basic mental health and social services, Susan Stefan, director of the National Emergency Department Project at the Center for Public Representation, writes in an opinion piece.

Two Boston orthopedic surgeons each received $6.75 million this year from a maker of joint replacement implants, the largest among hundreds of payments revealed in a $311 million settlement of a federal criminal case that alleged five companies paid doctors to use their products.

Dr. Richard Scott and Dr. Thomas Thornhill of Brigham and Women's Hospital were paid royalties and consulting fees this year by the Johnson & Johnson subsidiary DePuy Orthopaedics, according to documents made public by the company last week. DePuy makes implants used in hip and knee replacements.

Four other companies -- Zimmer Inc., Biomet Orthopedics Inc., Smith & Nephew Inc. and Stryker Orthopaedics -- were also part of an agreement with the US Department of Justice. The five companies, which together share 95 percent of the market for hip and knee implants, were being investigated for using consulting agreements with orthopedic surgeons to influence their choice of implants. Making payments was a common practice from 2002 through 2006, according to the US Attorney's Office in New Jersey.

The disclosures come as payments to doctors by device and drug companies come under increasing scrutiny because of concerns they create a financial conflict for physicians. But the industry, and many doctors and hospitals, defend the practice, saying it fosters innovation and properly rewards physicians for helping to develop new treatments.

Without admitting fault, the device companies agreed to make public their lists of payments for this year. Michael Drewniak, a spokesman for the US Attorney's Office, said in an interview yesterday that this year's payments were similar to amounts in previous years his office examined. More than 40 surgeons were paid $1 million or more this year, the lists showed.

Scott and Thornhill said in a statement supplied by Brigham and Women's that the royalties come from their design of a knee replacement implant licensed to J&J in 1986 and a hip replacement implant licensed in 1991. They said they donate their fees from consulting to charity.

"We are both very proud of the work we have done over the years to advance the mission of orthopedic medicine," their statement said.

Scott and Thornhill do not receive royalties when they or any other surgeons use their implants at the Brigham, they said. They did not break down the amounts of royalties and fees, nor were they available to comment beyond their statement.

DePuy, which will pay a fine of $84.7 million, issued a statement last week saying, "The surgeons who received the most significant compensation from DePuy Orthopaedics contributed intellectual property and ongoing expertise to the development of products."

Zimmer listed 15 Massachusetts General Hospital surgeons who received payments totaling $8.7 million this year. The hospital said in a statement that the money represents royalties for developing materials in the 1990s that are used in implants, and that the money goes to the hospital. Mass. General does not get royalties for implants that its surgeons use at the hospital.

"Ongoing research in orthopaedic surgery has led to enhancements in strength and durability of the materials, and the MGH continues to work with industry, including Zimmer and Biomet, to license and patent innovations that will benefit patients now and in the future," the hospital statement said.

Criminal complaints were filed against four of the five implant makers, charging them with conspiring to violate the federal anti-kickback statute, the US Attorney's office said, but the complaints will be dismissed if the companies comply with terms that include federal monitoring for 18 months and five-year corporate integrity agreements. Stryker cooperated with the investigation before the other companies and has entered a non-prosecution agreement with the government.

The state Department of Public Health today issued advice to schools and parents about a potentially dangerous germ that has infected a handful of students in recent weeks.

The bacteria, known as Methicillin-resistant staphylococcus aureus, cannot be treated by first-line antibiotics. However, the germ rarely results in serious, long-lasting health problems, specialists said.

University of Massachusetts Medical School cancer biologist Dr. JeanMarie Houghton (left) has won a Presidential Early Career Award for Scientists and Engineers. Her research focuses on the contribution of stem cells to cancer, in particular how normal stem cells that migrate to an area of chronic infection can develop into cancer cells. The award will extend her five-year National Institutes of Health grant for two years.

Boston University biomedical engineer James J. Collins has won a four-year, $1 million grant from the Ellison Medical Foundation to study the molecular basis of aging and the causes of diseases associated with it, such as Parkinson's and Alzheimer's.

Rhode Island Hospital in Providence has received a $5 million grant from the National Foundation for Trauma Care to improve its preparedness for public health emergencies.

To his patients, Dr. Abdul Razzaque Ahmed (left) was something of a modern-day Robin Hood, getting them expensive treatments they would otherwise not have been able to afford. Ahmed, of Brookline, pleaded guilty to a single count of obstruction and agreed to surrender $2.9 million in assets for deceiving Medicare to get treatment for patients with pemphigoid, a disease that was not covered by Medicare at the time.

A Superior Court jury ordered Dr. Edward Lipman and Dr. Akmal Khan to pay $4.1 million yesterday to the family of a 31-year-old woman who died in 1999 at Lowell General Hospital following gynecological surgery that the family's attorney argued was unnecessary and dangerous (fourth item).

Scores of Chelmsford High School students are to be tested for tuberculosis today after administrators learned Friday that a student at the school had contracted the disease, Superintendent Donald R. Yeoman said (fifth item).

Over-the-counter painkillers such as aspirin and ibuprofen can reduce the risk of Parkinson's disease, US researchers reported yesterday.

Bayer AG halted worldwide sales yesterday of its antibleeding drugTrasylol at the request of United States and foreign health officials pending further analysis of a Canadian study that suggests it's linked to a 50 percent higher risk of death than the other drugs in the clinical trial.

An advisory commission created in response to concerns about recalls of dangerous toothpaste, dog food, and toys will recommend to President Bush that the Food and Drug Administration be empowered to order mandatory recalls of products deemed a risk to consumers, an administration official said yesterday.

Estrellita Karsh, a former medical writer and historian, is getting things done in a manner that reflects her passions for medicine, art, and the photography of Yousuf Karsh. She is bringing art - and her husband's photographs - to hospital corridors.

About 1 in 7 teenagers in Massachusetts and Vermont might have a substance abuse problem, according to screening questionnaires filled out during routine doctors’ visits, a study has found. The adolescents' answers were more likely to indicate a problem during an appointment when they were sick or injured than when they were having a checkup.

“Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only,” wrote Dr. John R. Knight of Children’s Hospital Boston, lead author of the study in this month’s Archives of Pediatrics & Adolescent Medicine.

Researchers from Children’s, Tufts-New England Medical Center, Cambridge Health Alliance, the University of Vermont and Fallon Clinic in Worcester asked more than 2,000 12- to 18-year-old patients to answer six questions: five about using alcohol or other drugs and one about engaging in risky behaviors, such as riding in a car with someone who was impaired. Two 'yes' answers meant the teen screened positive for substance abuse.

Overall, 14.8 percent of patients said yes to at least two of the six questions. The most positive responses to the questions came in school-based health centers, at just under 30 percent of patients, followed by rural family practices, at about 25 percent. At sick visits, 23.2 percent of the screenings were positive, compared with 11.4 percent of well visits.

Positive screenings do not establish a diagnosis, the authors write, but they do require follow-up. Noting that sick visits are generally allotted less time than well visits, they suggest healthcare providers be trained in how to help patients who test positive by either offering brief advice or referring them for counseling or treatment.

Massachusetts slipped to ninth place in national health rankings released today, down two spots from last year.

Compiled by the United Health Foundation, the American Public Health Association and the Partnership for Prevention, the report said the overall healthiness of all states has declined by 0.3 percent. The national standings have stagnated since 2000, the report said, after steady improvements from 1990, the survey's first year.

Vermont came in first, followed by Minnesota, Hawaii, New Hampshire and Connecticut in the top five. Mississippi ranks as the least healthy state, along with Louisiana, Arkansas, Oklahomaand Tennessee in the bottom five.

In Massachusetts, both infectious disease and smoking rates declined. But more children were living in poverty and more people had no health insurance, the report said in its assessment of significant changes. The rating of insurance coverage was based on 2006 data, before Massachusetts' new healthcare law requiring near-universal coverage went into effect on July 1.

The rankings' 20 measures of health include obesity, tobacco use and violent crime as well as cancer and cardiovascular deaths.

Massachusetts scored well for its high levels of immunization coverage, low rates of obesity, and ready access to primary care, but the report said the state faces challenges with high prevalence of binge drinking, preventable hospitalizations and violent crime.

The percentage of children in poverty grew from 11.6 percent to 13.6 percent and the rate of uninsured people rose from 9.2 perent to 10.4 percent, according to the report. Infectious disease cases fell from 23.7 per 100,000 to 20.9 and the prevalence of smoking dropped from 18.1 percent to 17.8 precent.

Within the next decade or so, a new generation of Earth- and space-based telescopes should be probing the farthest, faintest regions of the heavens, putting sharp focus on the formation of the first stars and galaxies.

Faced with the prospect of getting older, Germans worry most about losing their memory or their mental alertness. The Dutch fear gaining weight, and Thais worry about fading eyesight. Americans, by contrast, don't agree on just one major worry - they spread their top concern among loss of energy, trouble caring for themselves, memory loss, and weight gain. And Egyptians face the oncoming years with aplomb, reporting relatively few concerns.

West Nile virus has established a firm foothold in an arc of states stretching from Minnesota through the Dakotas, Colorado, and out to California. Of the 3,195 human cases reported nationally this year, nearly 85 percent were recorded west of the Mississippi River.

Brad Buran (left) lost his hearing when he was 14 months old, after meningitis damaged the hair cells of his cochlea. He's now a doctoral candidate in the Harvard-MIT Division of Life Sciences and Technology -- not because he wants to cure himself but because he has found deep fascination in the one organ that has failed him.

An international team led by a Boston researcher yesterday unveiled the most detailed look ever at the genetic ravages inside a lung tumor, finding at least one target for drug research and laying the foundation for an ambitious - and controversial - federal effort to identify all the DNA damage that causes major cancers.

Democrats and healthcare advocates are expressing increasing confidence that their emphasis on expanding children's health insurance - a measure already vetoed once by President Bush - has succeeded in putting healthcare on the national agenda.

A growing movement to restrict smoking in apartments and condominiums is having some success.

Patients who received drug-eluting stents were no more likely to die or suffer a heart attack than those who got bare-metal versions, researchers found in a large US study that adds to the debate over the safety of the artery-opening devices.

Diana Owen (left, with Bryanna-Rose) told doctors her daughter’s projectile vomiting was getting worse. While sleeping, the mother had said, the child sometimes skipped breaths. Owen worried that her only child might die of an undiagnosed condition, Patricia Wen reports in Sunday's Globe.

Owen came to the chilling realization that she was being accused of making up - or even intentionally causing - her daughter's ailments. From her healthcare background, she had heard of the diagnosis the doctors pinned on her: Munchausen by Proxy, a rare mental disorder in which caretakers fabricate or induce illnesses in their children to gain attention from doctors.

Her daughter was placed into the protective custody of the Massachusetts Department of Social Services. This marked the start of one mother's odyssey to prove her sanity, a task that would require painstaking persistence as authorities clung to their original judgment of her.